Provider Demographics
NPI:1003051665
Name:CHANG, JIHEE (OTR/L)
Entity type:Individual
Prefix:
First Name:JIHEE
Middle Name:
Last Name:CHANG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3226 UNION ST STE 1B
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-3197
Mailing Address - Country:US
Mailing Address - Phone:917-563-1921
Mailing Address - Fax:917-563-1905
Practice Address - Street 1:3226 UNION ST STE 1B
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3197
Practice Address - Country:US
Practice Address - Phone:917-563-1921
Practice Address - Fax:917-563-1905
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-11
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014663225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY04956598Medicaid